Guidelines for Colonoscopy Surveillance after Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society*,§

Authors

  • Dr. Sidney J. Winawer MD,

    1. Winawer is Paul Sherlock Chair in Medicine, Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
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  • Dr. Ann G. Zauber PhD,

    1. Zauber is Associate Attending Biostatistician, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
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  • Dr. Robert H. Fletcher MD, MSc,

    1. Fletcher is Professor, Ambulatory Care and Prevention, Harvard Medical School, Boston, MA
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  • Dr. Jonathon S. Stillman MD,

    1. Stillman is Gastroenterology Fellow, Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
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  • Dr. Michael J. O'Brien MD, MPH,

    1. O'Brien is Professor, Medical Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA
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  • Bernard Levin MD,

    1. B. Levin is Vice President, Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX
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  • Dr. Robert A. Smith PhD,

    1. Smith is Director, Cancer Screening, Cancer Control Science Department, American Cancer Society, Atlanta, GA
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  • Dr. David A. Lieberman MD,

    1. Lieberman is Chief, Division of Gastroenterology, Oregon Health and Science University, Portland, OR
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  • Dr. Randall W. Burt MD,

    1. Burt is Interim Executive Director, Huntsman Cancer Institute; and Professor of Medicine, University of Utah, Salt Lake City, UT
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  • Theodore R. Levin MD,

    1. T.R. Levin is Associate Chief, Gastroenterology Department, Kaiser Permanente Medical Center, Walnut Creek, CA
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  • Dr. John H. Bond MD,

    1. Bond is Professor of Medicine, University of Minnesota; and Chief, Gastroenterology, Minneapolis VA Medical Center, Minneapolis, MN
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  • Dr. Durado Brooks MD, MPH,

    1. Brooks is Director, Prostate and Colorectal Cancer, Cancer Control Science Department, American Cancer Society, Atlanta, GA
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  • Dr. Tim Byers MD, MPH,

    1. Byers is Program Leader, Clinical Cancer Prevention and Control; and Professor, Department of Epidemiology, University of Colorado, Denver, CO
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  • Dr. Neil Hyman MD,

    1. Hyman is Chief, General Surgery, University of Vermont, Burlington, VT
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  • Dr. Lynne Kirk MD,

    1. Kirk is Tim and Toni Hartman Professor, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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  • Dr. Alan Thorson MD,

    1. Thorson is Clinical Associate Professor of Surgery, Creighton University School of Medicine and the University of Nebraska College of Medicine; and Program Director, Section of Colon and Rectal Surgery, Creighton University, Omaha, NE
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  • Dr. Clifford Simmang MD,

    1. Simmang is Associate Professor of Surgery, Department of Colon and Rectal Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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  • Dr. David Johnson MD,

    1. Johnson is Professor of Medicine; and Chief, Gastroenterology, Eastern Virginia School of Medicine, Norfolk, VA
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  • Dr. Douglas K. Rex MD

    1. Rex is Chair, US Multi-Society Task Force on Colorectal Cancer; and Professor of Medicine, Indiana University School of Medicine, Indianapolis, IN
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  • *

    *This article is being published jointly in CA: A Cancer Journal for Clinicians (online: May 30, 2006; print: May/June 2006) and Gastroenterology (print: May 2006) by the American Cancer Society and the American Gastroenterology Association.

  • © 2006 American Cancer Society, Inc. and American Gastroenterology Association, Inc. Copying with attribution allowed for any noncommercial use of the work.

  • §

    This article is available online at http://CAonline.AmCancerSoc.org

Abstract

Adenomatous polyps are the most common neoplastic findings uncovered in people who undergo colorectal screening or have a diagnostic workup for symptoms. It was common practice in the 1970s for these patients to have annual follow-up surveillance examinations to detect additional new adenomas as well as missed synchronous adenomas. As a result of the National Polyp Study report in 1993, which demonstrated clearly in a randomized design that the first postpolypectomy examination could be deferred for 3 years, guidelines published by a gastrointestinal consortium in 1997 recommended that the first follow-up surveillance be 3 years after polypectomy for most patients. In 2003, these guidelines were updated, colonoscopy was recommended as the only follow-up examination, and stratification at baseline into lower and higher risk for subsequent adenomas was suggested. The 1997 and 2003 guidelines dealt with both screening and surveillance. However, it has become increasingly clear that postpolypectomy surveillance is now a large part of endoscopic practice, draining resources from screening and diagnosis. In addition, surveys have demonstrated that a large proportion of endoscopists are conducting surveillance examinations at shorter intervals than recommended in the guidelines. In the present paper, a careful analytic approach was designed addressing all evidence available in the literature to delineate predictors of advanced pathology, both cancer and advanced adenomas, so that patients can be more definitely stratified at their baseline colonoscopy into those at lower or increased risk for a subsequent advanced neoplasia. People at increased risk have either three or more adenomas, or high-grade dysplasia, or villous features, or an adenoma ≥1 cm in size. It is recommended that they have a 3-year follow-up colonoscopy. People at lower risk who have one or two small (<1 cm) tubular adenomas with no high-grade dysplasia can have a follow up in 5 to 10 years, whereas people with hyperplastic polyps only should have a 10-year follow up as average-risk people. Recent papers have reported a significant number of missed cancers by colonoscopy. However, high-quality baseline colonoscopy with excellent patient preparation and adequate withdrawal time should minimize this and reduce clinicians' concerns. These guidelines were developed jointly by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society to provide a broader consensus and thereby increase utilization of the recommendations by endoscopists. Adoption of these guidelines nationally can have a dramatic impact on shifting available resources from intensive surveillance to screening. It has been shown that the first screening colonoscopy and polypectomy produces the greatest effects on reducing the incidence of colorectal cancer in patients with adenomatous polyps.

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